On Reactionary Medicine: Ryan Meili’s Healthy Capitalism

When I saw Ryan Meili posing in the same photo as Saskatoon Police Chief Clive Weighill, I was confused at first.

Ryan Meili is a physician and prominent activist based in Saskatoon. He is also the founder of Upstream, an NGO that describes itself as “a movement to create a healthy society, and evidence-based, and people-centred ideas.”

Clive Weighill is a chief of the police force with long history of violence against Indigenous peoples and racial profiling. He is also the president of The Canadian Association of Chiefs of Police, an organization that represents police chiefs from all across Canada. While Weighill occasionally presents himself as progressive and pro-social justice, he is unapologetic about his support for police carding and flat out denies that the practice is racist.

Upstream recently published an interview with Weighill. In the interview, Weighill highlights the importance of alleviating poverty in order to reduce crime. Meili seems sympathetic.

Overall, seeing Meili collaborate with a police chief seemed like a “sell-out” thing to do. How can anyone who calls himself an advocate of social health work with a cop? How can racialized policing and targeting of poor people ever be healthy?

But when I read Meili’s book A Healthy Society: How a Focus on Health can Revive Canadian Democracy, I realized I was wrong. His collaboration with the police chief is not a contradiction, but entirely consistent with his politics that are characteristically colonial and pro-capitalist. They actually have a lot in common with one another in terms of how they see the world.

The Source

Both in his book and Upstream’s literature, Meili’s primary concern is social determinants of health, the notion that one’s health is determined by social conditions they live in. Again, this claim is seemingly radical as it seems to address what he sees as “the root cause” of illness.

Meili uses the analogy of a man who frantically tries to rescue drowning children who endlessly come floating down a river. What he doesn’t question is who is throwing them into the river upstream.

But upstream is merely above downstream. Social inequality is only an effect of broader social relations that structure oppression and exploitation. The term does not capture the essence of social inequality and the source of where the river really flows from: capitalism and settler-colonialism.

Healthy Colonialism

While Meili is seemingly aware of the plight of Indigenous peoples and the need to “work alongside them,” his understanding of their material conditions rests on the notion that Indigenous peoples are Canadians, rather than independent nations.

So long as Canada is a country divided, it cannot truly develop. When we come to recognize the value of the contribution of all people, and in particular those long neglected and marginalized, only then are we on our way to building healthy society.

This narrative is all too familiar. The recent shootings in La Loche, Saskatchewan are the result of supposed “neglect” northern Indigenous communities receive from the Canadian state, when it’s the opposite. In the words of Moontime Warrior:

It is not a coincidence that areas with high Indigenous populations are the areas deprived of access to food and health care. At its core, this is an issue of maintaining the dispossession of Indigenous people and the legitimacy of Canadian control; an attempt to destroy the nations and legal orders that we hold in our blood, our muscles, our stomaches, our minds, our mouths.

Poor living conditions on reserves and in urban communities are an outcome of colonial dispossession of Indigenous peoples. The very existence of Canada is founded on this dispossession. Yet the word ‘colonialism’ does not appear in Meili’s book even once.

Meili’s lack of historical awareness becomes clear when he discusses the “inattention” many on-reserve schools receive from the federal government by using the example of Attawapiskat. For Meili, the fact that these schools receive three times less funding than schools in the rest of Canada “doesn’t make a lot of sense.”

What teacher, presented with a student who was struggling in school, would intentionally give them a third less attention than the other students? Students in difficulty receive more attention, and rightly so. Wise teachers know that the earlier they address the difficulties of a struggling student, the brighter the future for that student and the better the experience for the entire class. The same wisdom should be applied to addressing key determinants of health such as education among the communities most in need, be they urban, rural or on-reserve, great attention and resources should be applied to deal with greater challenges.

This “wisdom” is such that Indigenous peoples are like children struggling to catch up with more grown up Canadians. Behind Meili’s veiled ignorance of Canada’s colonial roots is his implicit support for more benign and healthier colonialism.

If we really care about the health of Indigenous peoples, we need to support their right to self-determination, not the assimilationist agenda of the Canadian state Meili promotes. Indigenous peoples have every right to resist Canadian imperialism and struggle for national liberation.

Colonialism and Capitalism: Antagonistic Contradictions

What Meili fails to see is the relational aspect of colonialism. Indigenous peoples are colonized not because they are culturally inferior or socially disadvantaged, but because the colonizers take their land and colonize them.

The same can be applied to class analysis. Rich people are rich not because they are lucky. The rich are rich because they actively steal from the poor; a process David Harvey calls accumulation by dispossession.

Colonialism and capitalism are always relational.

Meili’s analysis of inequality is limited in this regard as he equates class with income. According to Meili, income is the most important determinant of physical, mental, and social health. How healthy we are is determined by how much money we have, rather than our relationship to means of production. The problem with this view is it defines class difference as unequal distribution of income, rather than relations of production.

Like the relationship between the colonizers and the colonized, the bourgeoisie and the proletariat are not only different from one another, but antagonistic to each other.

Interests of the proletariat to live a satisfying and healthy life directly contradicts those of the bourgeoisie who want to extract as much profit as they can from the proletariat and pay them as little wage as possible. And in order for capitalists to extract profit more effectively, workers are best left dispossessed and propertyless.

The paradox, however, is that the very existence of the capitalist class is dependent on the working-class labour.

The Black Panther Party’s Service to the People Programs are a prime example of revolutionary medicine.

Poverty Profits

Looking at class in relational terms enables us to see through Meili’s thesis that “poverty is a drag on the economy,” reproduced in Upstream’s Poverty Costs campaign:

When people live in poverty they are unable to participate fully in public life and the marketplace, and are unable to contribute to the common account through taxes. They are also more likely to require health services, fall into the prison system, or require social assistance, People who do not have decent housing or access to education are less able to participate in the economy as customers, workers, or innovators. As their health suffers, the costs are borne by taxpayers. Our jails are now filled with hardened criminals (at least not when they got in): the vast majority of crime against property are people stem from poverty. Our safety, prosperity, and satisfaction with society are decreased by gross inequality.

While Meili is right to point that poor people are more likely to have health issues and end up in the prison system than the rich, the notion that you cannot contribute to society while living in poverty is bogus. There are three reasons why this is so.

First, it promotes the notions that the only way to contribute to society is by spending money and paying taxes. Society functions not because people spend money and pay taxes, but because people work. Capitalism cannot survive without people selling their labour for wage.

The fact that people live in poverty doesn’t mean that they don’t work. A recent report characterized Toronto as Canada’s “capital of working poverty” with the increasing number of workers in low-paid and precarious employment.

The fact that your labour isn’t fairly compensated doesn’t mean it is worthless either. Public health is impossible without city workers collecting garbage, janitors cleaning buildings, and nurses caring for the sick. We won’t have running water without plumbers and food to eat without migrant workers picking vegetables. Even the prisoners contribute by working for as little as $4 a day. So the claim that the poor are less able to contribute to society because they can’t pay taxes simply isn’t true. Workers make the world go around.

Second, contrary to Meili’s claim, poverty is actually a profitable business. Lower your wage is, you become less of a burden for capitalists who profit off your labour.

Under capitalism, hospitals, housing, prisons, schools, and universities are all profitable enterprises. The fact that they are publicly funded or that their profits are appropriated by the Crown doesn’t make them less capitalist. They can only function through the capitalist relations of production in which one class exploits the labour of others.

Some of these enterprises rely entirety on the existence of poverty for their survival like the burgeoning NGO/Non-Profit Industrial Complex.

Third, the claim that poverty is costly is not very different from the neoliberal argument used to justify austerity measures: the poor are burden on the hardworking taxpayers, and social services/public health/post-secondary education is costing us too much so it’s time to cut back and tighten up the belt. Replacing “the poor” with “poverty” doesn’t change the fundamentally neoliberal nature of this argument.

Anti-Political Politics

Meili recognizes that, since social inequality is a political issue, so is the solution. Yet Meili’s politics is paradoxically anti-politics.

According to Meili, social inequality is a product of a lack of consensus in the political process where ideological differences, divisions, and disagreements hinder society from identifying common goals: health and well-being.

As politicians pander for popularity and pursuing their own ideological goals, ordinary citizens who are otherwise eager to get involved in politics grow frustrated and lose interest. Or worse, they become militant: “Honest intentions and frustrations are diverted from meaningful expression to angry demonstrations.”

What is needed, Meili claims, is “less politics, more democracy,” and “evidence-based policy” informed by empirical data rather than ideology. He laments: “Our democratic system is suffering, and the remedy is not harder fought, more polarized politics. What is needed to build a healthier society is deeper democracy.”

Meili accordingly proposes a complementary system of parliamentary and participatory democracy as an alternative governance structure in which citizens are invited to partake in the decision-making process. However, Meili defines democracy strictly in technical and procedural terms rather than political and substantive. He presumes that implementing more democratic means of decision-making would foster democratic culture.

While I fully recognize the importance of mass assemblies and neighbourhood councils in advancing socialism, without dismantling the current political structure that is thoroughly pro-capitalist and anti-democratic, such arrangements would either fail or become co-opted into the existing structure.

The people lose interest in electoral politics not because of too much politics or the presumed lack of consensus. It is the opposite. All major political parties in Canada are increasingly indistinguishable from one another. There are no real anti-capitalist, anti-imperialist, and anti-colonial alternatives in the current political system. The problem is not that the political system is technically deficient. It is rather that the wrong politics are dominating the process.

The notion that becoming less political and more “evidence-based” would mobilize popular support is incorrect. Bernie Sanders is popular because he is much more honest about his social democratic politics than Meili. Sanders is popular not because he has his facts straight, but because he is bold enough to call out the Wall Street, denounce police violence, and appeal to working-class people instead of elusive “middle-class” both Liberals and the NDP love to fetishize. Hell, even Justin Trudeau did a better job at being unabashedly liberal than Thomas Mulcair who did exactly what Meili proposes in his book: Less politics, more techniques. This is exactly why the NDP lost the last federal election.

Norman Bethune served as a front line surgeon in Spain during the Civil War, and later in China for the Communist Eighth Route Army. While in Spain, he developed a mobile blood-transfusion unit. He died of blood poisoning he contracted while attending to the wounded in China. His name is more popularly recognized in China than in his native Canada

Canadian social democrats severely underestimate the importance of ideology, and the intellectual capacity of the masses to understand political ideas. This is not something the radical left should be emulating. Working-class and oppressed peoples are more open to discuss stuff like capitalism, imperialism, colonialism, patriarchy than you think, when these ideas are applied to concrete social realities they live in.

People gravitate towards organizations that are unafraid to name the names and willing to do what it takes to win, not groups that endlessly pump out policy papers filled with graphs and numbers. This is also why the Tea Party was so popular. They may have had their facts wrong and their ideas were undoubtedly racist, but they still knew what they were up against and what they were for.

Reactionary Medicine

What is more troubling about Meili’s anti-political politics is his claim “Poverty and ill health affects us all.” According to Meili, addressing social determinants of health “helps everyone, regardless of their social position.” This approach supposedly enables us to “reach across divisions of class, race, geography, or political affiliation” and “offers us a shared goal with the power to reach across the differences that separate us.”

From an outset, this seems contradictory, especially for someone who thinks that the poor and marginalized are more likely to be ill than the rich. Clearly class and race have something to do here. But the true meaning of this “we are all in this together” appeal becomes more apparent in the following quote:

While the amassing of great wealth has an obvious appeal to those who are able to do so, it has a destabilizing effect on the society that makes them wealthy. Greater differences in income increase social distances. Cuts to health and education lead to increased social stratification and demand for social services. If these go unheeded as tax bases are eroded, crime increases, and is increasingly directed against the wealthiest. If this trend continues, you get political instability that threatens to disrupt the country, including for the wealthy. So rather than enjoying the hard work and good fortune, the wealthy find themselves living in gated communities, isolated from and afraid of the dangerous world around them. More equal societies, where the difference in fortunes between those at the top and bottom is a gap that could feasibly be crossed, are safer and more satisfying to live in.

Meili correctly recognizes that the politics of austerity lead to heightened class contradictions and popular discontent, but from a decisively reactionary and counterrevolutionary perspective. Worsening inequality, ghettoization, and geographical separation between classes would not only increase crime, but threaten the political order that protects the rich. And yes, thoughts of pending socialist revolution would cause great anxiety for the bourgeoisie.

What would Che say?

This is exactly what Meili does not want. What he means by a healthy society is nothing more than healthy capitalism. What he envisions is a society with less inequality, but is unequal enough so the rich can still finance the state and take care of the poor…or otherwise scary communists would take over.

His anxiety towards ghettoization is also similar to what drives the process of gentrification, and underlies its ideology of ‘mixed’ neighbourhoods where diversity of classes and races is celebrated, but only within terms acceptable to developers, businesses, and wealthy property owners.

We can see now that Meili’s collaboration with Saskatoon Police Chief is not inconsistent. It is perfectly consistent with his reactionary politics and emphasis on class peace as his preferred order of things.

Revolutionary Medicine

While Meili presents himself as an advocate for the poor, his politics are actually colonial and pro-capitalist. Yet he has the sheer audacity to open his book with a quote by Norman Bethune, a Canadian communist physician whose service to the Chinese Revolution and resistance to Japanese imperialism made him a hero of the Chinese people.

Unlike Meili, Bethune had no illusion that the health of Chinese people would also benefit the Japanese invaders. Neither did Che Guevara believe that eliminating inequality in Cuba would increase the safety of the Batista regime backed by the U.S. The Black Panther Party knew fully well that running free medical clinics was part of their struggle against imperialism.

What these revolutionary doctors had in common was that they were unapologetic about being political and being doctors at the same time. They all had their evidences, but they used them to advance revolutionary goals. Their medical practice was guided by revolutionary politics.

They were keenly aware that the choice was between the people or the oppressors, and that capitalism, imperialism, and colonialism were obstacles to realizing a healthy society. They all knew who their friends and enemies were.

Let’s not forget the invaluable and often unacknowledged contributions they made to the history of medicine. There is nothing unhealthy about being revolutionary. Many revolutionaries died so others can live. It is a medicine we cannot take for granted.

I would just like to add a few comments that are intended to stand as neither a defense of Meilli’s work, nor a retort of your over-arching message.

When Ryan Meilli wrote “A Healthy Society” he did so before he decided to run for leader of the Saskatchewan NDP. Also worth noting, he draws heavily on a book that posits its arguments at a much broader context than just Saskatchewan. The book he drew influence from is “The Spirit Level.” Both of these works easily fit within the reformist traditions of politics on the Left.

Thank you for the amount of work you put into this. Your opinion definitely matters on this and the other topics on which you have commented.